by Dr. Daya Somasundaram
Department of Psychiatry,
University of Jaffna, Sri Lanka
Helplessness
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(August 23, Melbourne, Sri Lanka Guardian)50 year old Vani was a shopkeeper from Tharmpuram with three children. The eldest daughter was married with two daughters. The second son had been forcefully taken away by the Iyakam (movement- LTTE) a year ago. When the fighting became severe in January, they loaded their belongings in a landmaster and with other village folk were displaced from place to place. The 13th displacement was to what had been declared a safety zone, Iranaipalam where they stayed for 10 days. People had made tents to live in. As shells had started falling on that day, they loaded their goods onto the landmaster and decided to move on. But her 8 year old granddaughter insisted on having fried fish, they delayed to cook a meal. Varatharany and her daughter busied themselves in cooking while her husband, son and grandchildren were sleeping in the tent. Her Son-in-law had gone to the market.
That day, 21/2/2009, morning at 11:45 AM a shell fired by the army completely buried their families happiness in a deep hole and made them nirkathy (helpless). The shell not only landed on the landmaster burning it, but also pali eduthiduthu (killed) her husband, son and two grandchildren. Varatharany and her daughter were injured. On hearing her daughter wailing "my children are dead", she had gone slowly when she saw her husband lying dead, her grandchildren with their bodies thundikapadu (severed) and her son injured in his head, arms and legs struggling to live. She collapsed there. On hearing her distraught daughter who despite bleeding profusely had run over and was trying to pick up her kuttuyir (barely alive, process of dying) children while lamenting loudly, bystanders had come and taken them to hospital. The son-in-law had come later and buried the dead with the help of others there.
Both of them were treated for two days at Trincomalee hospital, then sent to Vavuniya hospital and currently at the Saiva Prihasa School refugee camp। For the last one month, Varatharani and her daughter have been continuously crying with constant memories of their children and re-experiencing what happened. They are disturbed by suicidal thoughts, fatigue, insomnia, and guilt feelings. Although they say that her son-in-law is their comfort, when he is alone he laments loudly saying, "We have lost our relations and our belongings. There is no point in having come here. I am useless" (he had survival guilt, of not having been there to help his family when the deaths happened).
Interviews
Key-informant, family and extended family interviews and focus group discussions regarding family and community level changes indicated mostly negative but also positive developments (see Table 1). Generally there was consensus that family and community life had suffered due to deaths, separations and deprivations. Relationships, trust, cohesion, beliefs and ethical values had declined, some said deteriorated, destroyed. Instead there was an increase in misunderstandings, conflict, selfishness, suspicions, anger, bitterness, virakthy (loss of interest), veruppu ( state of detestation), soham (sorrow), alcoholism and sexual laxity. The problems associated with the increase in alcoholism and sexual laxity has been raised consistently by health workers in the camps. Expression of survival guilt was common, particularly after the experiences in the internment camps. After losing so many of their relations or not knowing their whereabouts, many said they could rather have died in the shelling. Outward blame for what happened was common, some blamed the government; others India (vaddakathiyar- northerners) and some the LTTE. There was anger and feelings of betrayal by the LTTE. In the immediate aftermath, many were distraught, dazed and disoriented; there were strong feelings of disillusionment, bewilderment, disbelief, bitterness and utter devastation (see Figure 7[88]). Some said it was the fate of the Tamils (thalaivithiy), 'of having been born Tamil in this country'. Most felt that there had been a decline in religious beliefs and practices, loss of faith and fervour. One widow described how she and her children had left her husband who had been shattered by a shell but still alive and struggling on the road to escape themselves. She is haunted by this memory and blamed God for creating the terrible situation (pallapona kadavul). But others mentioned that it was only religion and faith in god that had sustained them when everything else failed. Their only trust was that God would find a way out for them. Some mentioned an increase in new relationships; mutual help and co-operation; a sense of unity, comaradeship and togetherness by being thrown together against adversity which was marked during the last days of the 'final war' and thereafter for a short period but had progressively decreased. A common observation was that people had become dependent on handouts, used to welfare and decline in efforts to work and earn. People had betrayed (kaddikodduthu) others for benefits and privilege from the army and authorities. But, now with the resettlement process, motivation to rebuild their lives and livelihood was strong. There was a sense with some exceptions (those who had suffered and lost most) that their situation was improving and there was hope for the future compared to how it was one year ago. There were some positive stories of resilience and post-traumatic growth. A senior government officer and writer said that they had gone through great hardship (peravalam), but that they now only needed to get back their infrastructure, resources, occupational opportunities and jobs to rebuild and restart their lives. He denied any ill effects like poor sleep, bad dreams or loss of motivation. He appeared in good health and committed to contribute to the resettlement and rehabilitation process. A recent (2010) observation of what is happening in the Vanni echoes this positive hope, "the spirit of the Tamils in the north has not been extinguished by the long years of war and its brutal end. All indications point that the Tamils will rise again to play a meaningful role in Sri Lanka and prosper. The spirit that is manifesting itself in numerous ways all over the north, despite the all too obvious adversities and disadvantages, is definitely a harbinger of a bright future for the Tamils and Sri Lanka. If they are helped and guided, they will advance faster. If not, they will yet become a great people, though at a slower pace. The Tamils will emerge from their prolonged tragedy and the associated misery, despite their politicians, bureaucrats and malcontents- both within and the Diaspora, to become what they deserve to be in the land of their birth and life. I may not live to see this happen, but will die convinced, it will happen. Tamils are not a species, destined for extinction in Sri Lanka, as many, including me had feared six months back. They are proving that they have what it takes to rebound from adversity and hurdles, to survive and prosper" [89]. A young doctor who had served through the last days of the fighting said that he had seen terrible injuries and deaths, struggled through the heavy shelling and firing at the different hospitals, working without rest. At one stage he had lost all fear and was able to continue working amidst all the chaos. He was ready to do anything. He was now seen to be extraordinarily dedicated, motivated, a tireless worker and administrator appreciated by all. An expatriate medic also described the last days of fighting as harrowing but "After looking at the people dying and dead bodies everywhere, it is like nothing threatens me anymore, it is like I have had the hard time in my life and I think I am prepared to take up whatever happens in life now. I'm not that old Vany that sits down and cries for little things. I'm stronger now after going through and seeing all that problem. My mind is clear now"[90].
Table 1 : Collective Trauma-Theoretical model
Discussion
There are several themes emerging from accounts of what happened. A striking theme to emerge from the narratives is the collective nature of the trauma. All the stories describe what happened to them as a family or in some cases, to the community. Western research and conceptualizations have been primarily individualistic in orientation [91]. The fields of social theory, modern medicine, research and academic activities in general are dominated and monopolized by the western individual oriented paradigm. However, in collectivistic, co-operative societies [78,92], there is a need to go beyond the individual to the family, group, village, community and social levels to more fully understand what is going on in the individual, whether it be his/her development, behaviour, perceptions, consciousness, experiences or responses to stress and trauma as well as design effective interventions to help in the recovery and rehabilitation of not only the affected individuals but also their families and community[93-96]. For when the family and/or community regained their equilibrium and healthy functioning, there was often improvement in the individual member's wellbeing as well. Family and social support, networks, relationships and the sense of community appears to be a vital protective factor for the individual and their families and important in their recovery. This broader, holistic perspective becomes paramount in non-western, 'collectivist' or co-operative cultures which have traditionally been family and community oriented, the individual tending to become submerged in the wider concerns[29,78,92,97]. The family and community are part of the self, their identity and consciousness. The demarcation or boundary between the individual self and the outside becomes blurred. The well being of the individual member is experienced as the wellbeing of the family and community. For example, Tamil families, due to close and strong bonds and cohesiveness in nuclear and extended families, tend to function and respond to external threat or trauma as a unit rather than as individual members. They share the experience and perceive the event in a particular way. During times of traumatic experiences, the family will come together with solidarity to face the threat as a unit and provide mutual support and protection. In time the family will act to define and interpret the traumatic event, give it structure and assign a common meaning, as well as evolve strategies to cope with the stress. Thus it may be more appropriate to talk in terms of family dynamics rather than of individual personalities. There may be some individual variation in manifestation, depending on their responsibilities and roles within the family and personal characteristics, while some may become the scapegoat in the family dynamics that ensues (see family case histories[42]). Similarly, in the Tamil communities, the village and its people, way of life and environment provided organic roots, a sustaining support system, nourishing environment and network of relationships. The village traditions, structures and institutions were the foundations and framework for their daily life. In the Tamil culture, a person's identity was defined to a large extent by their village or uur of origin [98]. Their uur more or less placed the person in a particular socio-cultural matrix. However, within communities, there may be exclusion, ostracization, powerlessness, marginalization, silencing and stigmatization of some members, families, castes or groups while others seek prower and privilege. The social institution of a traditional uur has also undergone tremendous breakdown with the chronic war and displacements as well as modernity.
It is becoming clear that social and cultural values, beliefs and perceptions will shape how traumatic events impact on the individual, family and community and the way they respond [99,100]. The meaning attributed to the event(s), the historical and social context, as well as community coping strategies determines the impact and consequences of trauma (Table 1). The narratives clearly show the impact of the war on the family and community. The exclusively individual perspective characteristic of western narratives is completely lacking here. There are hardly any spontaneous complains of individual symptoms or suffering. Even where a person talks of his or her personal agony, it is framed in general terms, reflecting what happened to the family or community. Undoubtedly, individual symptoms, how the trauma had affected each member can be elicited with direct questioning [42] as in the PTSD example above. But in this study, the narrative was allowed to flow naturally. The story usually began with the family described metaphorically as living happily in their village. It is significant that the happiness or wellbeing is perceived and experienced in terms of the family and community. There is a dynamic equilibrium, harmony within the family and community, a network of mutually supportive relationships and responsibilities, ritualistic practices and living patterns that they have managed to establish despite the harsh socio-economic and political conditions. Their feeling of strength and value is more in those bonds and relationships not so much in the material and external circumstances. The war is seen as an imposition coming from outside, disturbing this atmosphere of contentment where the family and community was progressing, getting on with life. The war is invariably described in very negative terms, por arrakan ( war devil), kodum (horrible), per avalam (great calamity). As the narrative unfolds, it is the family that is the focus. The shelling and fighting approaching their homes, their village, impels them to start the displacement process. They describe how they leave as a family, as a community- whole villages, taking whatever they can load onto vehicles, hoping to return in a day to two. The dispersion begins. Initially they are separated from the supportive context of their community, extended family and village. How the new conditions start affecting the family, how each member suffers, the deaths and injuries, how the separations form those who are injured, having to bury the dead without the customary rites, the guilt of leaving relations behind, and the strong yearning to know what happened to other members. The impact of the disaster is felt acutely within this living fabric of the family and community: the utter hopelessness, helplessness and devastation when the fabric is torn.
In these circumstances the best approach to restore the psychosocial and mental health of the Vanni IDP's according to mental health professionals working in the internment camps as well as clearly recommended in the Interagency Standing Committee (IASC) guidelines for mental health and psychosocial support in emergency settings[101] would have been to re-unify the family, give information on their fate and whereabouts. The second best strategy would have been to release them to find their own way and reunite with their families and community. However, the state strictly resisted these well meant efforts. If one is to extrapolate from the decisions and restrictions being placed by the authorities, discern the pattern behind the policies from past analysis [61] and experience to understand the mindset [51], the operating paradigm, it would appear that the state still fears a regrouping of the destroyed LTTE, but more harbours a deep paranoia based on ethnocentric perceptions of the 'other' [41] to prevent any future minority mobilization. There was only limited psychosocial support, while counselling or cultural healing practices either in the camps or resettlements was severely restricted [2,102,103]. In the post-conflict, military and politically sensitive situation, dealing with the mental health and psychosocial needs of the Vanni IDP's was a difficult and challenging task. A small team of mental health professionals and few NGO's with limited resources attempted to address the immediate and urgent needs. The priority was given to severe mental illness, particularly psychosis, which needed medication and intensive care. Some chronic patients had relapsed or developed exacerbation in their symptoms when they had run out of drugs or simply stopped taking them. A large number had been displaced from long care institutions in the Vanni, Vetti mannai and Santhosam, which were caring for over 100 chronic patients from all over the island. Some had developed psychotic illness anew. Clinics were held in the camps and Vavuniya hospital while in ward treatment was available at the General Hospital. Similar secondary and tertiary care was available in Jaffna and Mannar. However when it came to addressing the psychosocial needs, access was limited. Ingenious strategies had to be adapted to gain access and provide support despite the military presence. A group of community level workers, Community Support Officers (CSO's), who had been trained after the tsunami under a Ministry of Health/WHO programme [104,105] to work with the affected population in the Vanni were among the IDP's in the camps at Vavuniya. They were again mobilized by a Ministry of Health/WHO programme to work among the IDP's. Some other psychosocial NGO's did yeomen service under trying circumstances. Nevertheless, consistent and systemic long term programmes were not allowed. The Mental Health Consultative Forum for the Northern Province consisting of mental health professionals and health administrators from the health department was formed in November, 2009 to deal with the Mental Health needs in the resettlement process of the IDP's. The Forum has formulated a plan to mobilize those already trained and skilled in community level mental health to form a network of psychosocial support at the periphery (Divisional (AGA) or District Levels (GA)). Other community level and governmental workers can be trained. Training of grass root community level workers in basic mental health knowledge and skills is the easiest way of reaching a large population. They in turn would increase general awareness and disseminate the knowledge as well as do preventive and promotional work. The majority of minor mental health problems could be managed by community level workers and others referred to the appropriate level. The main effort of community level workers would be directed towards strengthening and uniting families; rebuilding and regenerating community structures and institutions; encouraging leaders; facilitating self-support groups; village and traditional resources; using creative arts; cultural, ritualistic practices; as well as linking up with other service sectors like education, social service, local and regional government. However, the state does not recognize the concept of psychosocial needs or support. For example, knowledge that apart from other physical and socio-economic needs, it will take considerable time and psychosocial support for the people to get over their trauma is not accepted. The Vanni IDP's will have to be given an opportunity to mourn for the dead, grieve for the losses and practice the cultural rituals for collective consolation. What happened cannot simply be erased from collective memory. If proper healing and psychosocial restitution is not done properly or they are pushed into activities too quickly, they may not benefit fully from the resettlement, rehabilitation and development efforts. They will lack the motivation and well being to participate fully in their recovery and rebuild their homes, lives and the region. Nevertheless, in the long term, one would expect the Tamil community to eventually recover despite the malfeasance [89]. Although it is a much more complex and chronic sociopolitical situation in Lanka, the community's resilience that lies in its strong identity, culture, social and spiritual practices will help heal the wounds as happened naturally, despite all the shortcomings and neglect, after hurricane Katrina in New Orleans [106].
A broader and long term psychosocial intervention for collective catharsis and a healing of memories for traumatized families and community would be an acknowledgement of what happened. Apparently the state did not want the stories to get out for fear of prosecution for war crimes that was being put forward by some members of the local and International community [2]. It continued to insist that 'not a single drop of civilian blood had been shed' and the 'biggest humanitarian rescue mission in history' had been executed [107]. The politics of memory and history writing are linked to power. Those with the power to impose their version can change memory traces and perceptions of what happened. The LTTE managed to enforce their account of the 1995 exodus in the memory and imagination of Tamils as resulting from state action when they in fact engineered a movement of over 400,000 people from Jaffna [53]. The Jaffna exodus, many of whom ended up in the Vanni, and its context had many similarities to what happened later in the Vanni except that there wasn't such large scale civilian deaths and injuries. The LTTE then chose to withdraw into the Vanni jungles rather than make a last stand in Jaffna with civilians, avoiding a similar humanitarian disaster[54].
Around thirty thousand civilians appear to have been killed and scores more injured in a short period with large scale, repeated displacements, shortages and neglect of basic needs such as food, shelter and medical care. Allegations of war crimes, and crimes against humanity have been raised at the highest levels calling for investigations and persecution by world bodies [1-3,6-8,69,70,108]. There have also been heavy casualties among the army. According to reliable reports around 5000 soldiers died while many times more were injured in the final push [109,110]. Perhaps 7,000 LTTE militants died or were executed in 2009 alone. Many were raw conscripts pressed gang into battle to became cannon fodder. From past experience with such battles and casualty figures, a conservative estimate for the whole Vanni battle may be well over 10,000 killed for each side. The story of ordinary soldiers and militants also needs to be told; their sacrifices, suffering and agony recognized; accepted for healing of their memories; and ultimately, for national reconciliation. It becomes abundantly clear that both the Sri Lankan state and the LTTE are responsible for serious human rights violations on a large scale. Though indictments or establishing moral responsibility may not be realistic in the current international, regional and local political context; at least, reinstituting a belief in social justice would be an important psychosocial intervention for communal harmony and wellbeing as well as the future of the country.
However, another interesting theme that emerges from the narratives is the contest for the loyalty or obedience, the so called 'hearts and minds' exercise, that operated to a large extent at the unconscious level. Evidently the Vanni civilians had some allegiance to the LTTE up to the beginning of the last phase of fighting in 2006. Many believed in the LTTE version of the 'freedom struggle' and had chosen to go to the Vanni, for example during the 1995 exodus from Jaffna [53], and stayed on despite the hardships and shortages. There had been considerable compulsion in making this 'choice' applied by the LTTE which also had a strict pass system preventing people leaving their area of control. Nevertheless, the LTTE and their sympathizers perceived the Vanni people as their loyal subjects with subtle gradation of animosity to Tamils living outside. A view shared by the Sinhala State as shown by their treatment of the Vanni IDP's after the conflict. Their forced internment in barbed wire camps was obviously a collective punishment for their 'crime' of staying in the Vanni with the LTTE (see Figure 8[111]). Those coming later in the battle were considered 'more loyal', particularly those who 'stayed' till the last. They were treated more harshly and punitively with far more restrictions in different zonal camps[112]. After the 1995 exodus, those who had stayed behind in Jaffna were issued 'Army' Identity Cards with differences entitling privileged status. The LTTE and people of the Vanni also considered them as somehow having betrayed the cause and enjoying special luxuries. As the fighting evolved with the Vanni civilians facing increasing harsher conditions of ubiquitous death, injuries, conscription, multiple displacements and shortages of food and other basic necessaries; this loyalty could be seen to gradually change. Under the totalitarian fascist control of the LTTE, any kind of dissent or counter views had been eliminated. People had adapted to this state of affairs despite embargos, restrictions and attacks by the state showing considerable resilience. They were content in many ways as expressed in the narratives metaphorically as being 'happy'.
The narratives speak of the beginning of the last phase of the war in particularly apocalyptical terms। But the criticism and antagonism to the actions of the LTTE starts creeping into the narratives much later. Many show a strong reluctance to name the LTTE directly, always using indirect terms. Some completely leave the actions and atrocities being done by the LTTE out of their accounts [80,90]. Apart from their more overt repression and terror, the LTTE had succeeded in establishing this kind of collective internal censor that prevented people seeing their negative side but more insidious, thinking or speaking about it. Partly this was due to terror and a survival strategy, but it was also a result of the discriminatory policies of the state and the harsh actions of its security forces. But as the price for this loyalty mounted with increasing death, injuries and conscription, the tide turned and people became more conscious of the real nature of the LTTE. It would appear that this was a deliberate 'psyops' military strategy of the state to drive a wedge between the civilians and the LTTE, as they increased the harsh conditions: shelling causing death and injuries even in hospitals and state declared safety zones, restrictions on food, medicine and other basic items[113]. The counter insurgency (CI) strategy appeared to have worked with people becoming more overt in their resistance to the LTTE, more open in criticism and defiance, at times breaking out into direct clashes [2,5]; finally escaping over to army control. Some narratives expressed gratitude to the state forces for having saved them from the LTTE. The state has continued to use this CI strategy to completely wean the Vanni people from the LTTE after the conflict by interning them in IDP camps with callous restrictions. They have sought to impose their version of the discourse in contrast to the ideas of liberation, Tamil homeland and separation. However, instead of using the historic opportunity for national reconciliation, the repressive ethnocentric approach without dealing with the underlying grievances in the long term will only alienate the minorities once again. Apart from the political implications, the contest of the different discourses at stake and the need of the Vanni IDP trauma for healing; if not social justice, the whole national reconciliation process at least needs some acknowledgement of what happened. If there is no healing of memories, merely a repression, the untreated collective trauma could well turn into resentment and rekindle cycles of violence once again.
Conclusions
The psychosocial and mental health consequences of massive trauma to individuals, families and communities can be profound. The interventions for recovery and regeneration should be holistic, integrated and multisectorial (Table 1). However, the underlying political context and struggle for control, power, discourse and obedience complicates what is allowed and can be done.
The following poem [114], Shady Trees, by a child soldier yearns for the solace from a caring, nurturing elder, community, society that has been laid waste by war:
In our lives
There is no peace
In our trees
There is no life
The dead ones become firewood
The green ones give shade
The onlooker...
You tell us
Which tree are we
Will you ease our worries?
Will you wipe our tears?
We are waiting
For the shady trees...
Competing interests
Tamil medical officer working in northern Sri Lanka
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