A community can be made to go through multiple experiences of being uprooted when entire villages are resettled and re-resettled, made to walk through corridors of terror, torture, censorship, and surveillance, and forced to see the militarization and brutalization of its children through systematic propaganda, hate speeches, and politically slanted history.
by Ashis Nandy
Editor’s Note: The following excerpts are adapted from Scarred Communities by Dr. Daya Somasundaram, a senior professor of psychiatry at the Faculty of Medicine, University of Jaffna, and a consultant psychiatrist. Originally published by SAGE in 2014, the book is no longer in print. However, it is now available as a free e-book, with donations requested to support Thapovanam, a nonprofit yoga and meditation centre located in Allaipiddy, an island off Jaffna. These donations will help cover running costs, maintenance, and pro-social programmes. Further details are provided in an addendum at the end of the book.
Ever since I read Daya Somasundaram’s first book in the late 1990s, I have always approached his writings with a mix of great anticipation and visceral discomfort. He has a clinical style which, even when dealing with gory violence, brings to his intellectual concerns not the calming touch of a family physician but the practical, robust, this-worldly presence of an engaged physician.
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| Jaffna still bears the scars of one of history’s longest and bloodiest guerrilla wars. [ Photo: Special Arrangement ] |
Somasundaram works on the long- and short-term effects of mass violence on communities and individuals. His gaze remains steadfastly clinical, yet that clinical gaze has a clear political and social edge. The prognosis—perhaps defying Somasundaram himself—might seem somewhat pessimistic to most readers. This pessimism is linked to the perspective that the psychological disciplines bring to conflict situations in the region from which both Somasundaram and I hail.
Though there is a rich tradition of exploring the psychological in South Asia, the public culture of the region has come to disdain it as soft, romantic, and a hindrance to tough-minded statecraft and political realism. Very few in the more articulate and audible sections of our societies, and none of the parties involved in a conflict, are willing to even listen to the kinds of analysis Somasundaram has ventured in his work. We in South Asia are becoming, by our own choice, hard-eyed, masculinized devotees of realpolitik and have begun to view anything psychological or dealing with human subjectivities with suspicion.
As a clinical discipline, modern psychiatry has consistently emphasized the suffering of the individual patient. This is as it should be. Most traditions of healing observe this rule, even when they underline the roles of society and culture in shaping the context and source of a patient’s suffering. In the southern hemisphere, such contexts and sources can be formulated more directly and even brashly. One could say, for instance, that cholera in the tropics is caused first by poverty and only then by the cholera bacteria.
You and I and our kind do not die of cholera, even if we are careless. Our environment and our class status sanitize and protect us, sometimes even when we are casual or careless about our personal hygiene. People living in slums have to more consciously take care of their personal and family hygiene and be more particular in their food habits and lifestyles. We also know by now, thanks to Ivan Illich, that no epidemic, except smallpox, has been eradicated by drugs and vaccination. Public health, hygiene, and improved quality of life have played a larger role in each case. And Illich, in retrospect, was modest in his claim because, even in the case of smallpox, subsequent research has shown that traditional methods of variolation had kept in check epidemics of smallpox in countries like China and India.
However, if you are a physician facing a case of cholera, your first job is not to enlighten the patient on the subtleties of social epidemiology or the social history of a disease but to take care of the suffering in front of you. Somasundaram’s work has always been a testimony to this double-edged responsibility of psychiatry, which cannot be shelved by giving a few ritual lectures on social psychiatry to students of medicine the way business schools teach business ethics and the social responsibility of business as trendy subjects with which future corporate bigwigs must be familiar so that they can navigate the upper echelons of society with self-confidence.
Those who have read Somasundaram’s first foray into this area in 1998, Scarred Minds: The Psychological Impact of War on Sri Lankan Tamils, have come to expect from him a heightened sensitivity to the larger responsibilities that disciplines like psychiatry bear in conflict zones. The author wrote that book with what many would consider admirable scholarly detachment, but it was nonetheless a powerful testimony to his awareness of the changing nature of mass violence in our times, particularly the predicament in which non-combatants, trying to live their normal lives and protect their familiar moral universe, get caught. The other name for this predicament is collateral damage, which interests neither the combatants nor the political class and the media.
The present book can be read as a companion volume to Scarred Minds. The psychiatrist’s job, in recent times, has not been a pleasant one, particularly when it comes to the mental health problems that modern warfare triggers. On the one hand, the number and proportion of non-combatants who die in wars and other forms of armed conflicts have begun to rise dramatically all over the world. Some estimates yield figures as high as 85 per cent. In addition, Somasundaram himself has shown elsewhere how civilian populations might be caught in the crossfire between competing forms of ethno-nationalist ruthlessness, paranoia, and systematic onslaughts on a community’s way of life.
A community can be made to go through multiple experiences of being uprooted when entire villages are resettled and re-resettled, made to walk through corridors of terror, torture, censorship, and surveillance, and forced to see the militarization and brutalization of its children through systematic propaganda, hate speeches, and politically slanted history. On the other hand, the diagnosis of post-traumatic stress disorder (PTSD) has become not only more frequent but also a double-edged instrument.
PTSD is no longer only a nosological category or a handy clinical diagnosis that names the psychological devastation caused by war, both among the victims of war and the perpetrators. PTSD can also simultaneously be a means of declaring an afflicted community as socially and culturally challenged and unable to take care of itself. Psychiatrists rarely recognize what is pretty obvious to political analysts and journalists—calling a community traumatized is nowadays also a way of handing over agency to international bodies and outside experts, who are then expected to look after its welfare as professional social workers and political negotiators. As if war-induced trauma were not enough, the diagnosis of PTSD introduces into the theatre of war a new means of infantilization.
This book is a collective effort that offers another form of psychosocial support system for the victim communities whose world has been torn apart by the experience of war—with family and community processes damaged, culture and belief systems altered beyond recognition, and daily life marked by suspicion and loss of hope, trust, and motivation. War has pushed them to the margin of despair and sometimes self-destruction. Somasundaram’s alternative seeks to go beyond individual psychotherapy, bypass the ornate clinical and psycho-pharmaceutical interventions, and emphasize instead the restoration of the dignity and autonomy of the victims and their networks of human relations, while being sensitive to the cultural, social, and psychological needs of the community. At the same time, it seems to be more affordable in resource-scarce societies.
In the post-Second World War period, civil wars have become a rather distinctive form of armed conflict. Even some of the major wars identified with countries such as Korea, Vietnam, Iraq, and Iran had a large component of civil war built into them. Over the years, in places like China, India, Cambodia, West and East Africa, and the Balkans, civil strife has taken a huge toll on human life, devastating entire communities and cultures. One main feature of such wars is that high casualties are not only seen as collateral damage but also quickly written off as ‘normal’ sacrifices for state formation and nation-building.
Somasundaram himself has shown in the context of the Sri Lankan civil war how civilians were caught between the conflicting demands and competing atrocities of the two sides and were seen as expendable cannon fodder by both sides. They are still waiting for justice and rehabilitation.
Under these conditions, where does the psychiatrist’s professional duty end and their responsibility as a citizen begin? Can resistance to war itself be part of a psychiatrist’s intellectual self-definition? Or should they consider that an avoidable digression that takes them outside the ken of their discipline and the familiar landscape within which professional ethics and the Hippocratic oath work? Does the psychiatrist’s responsibility end at the perimeter of the clinic, or does it extend to the epidemiology and the political sociology of the patient’s suffering? Can psychiatry claim to be a ‘total’ discipline, for which there is no alien territory, because human subjectivities, the psychiatrist’s main preoccupation, recognize no temporal and spatial borders?
These are questions to which there are no simple answers. The disciplines concerned with mental health have seen an enormous expansion in the range of psycho-pharmaceutical drugs. As a result, long-term psychotherapeutic interventions seem to be going out of fashion. The boundaries of the mental health worker’s awareness, too, have widened to include a larger range of social and cultural variables. No psychiatrist can avoid taking a look at the changing nature of human violence, believing it to be primarily the concern of political scientists and sociologists. Yet, one has the nagging feeling that these expansions are accompanied by an abridgment of the intellectual and philosophical self of psychiatrists, and in this abridgment, a crucial role has been played by a narrow definition of professionalism.
Daya Somasundaram, in this respect, represents neither the conventional boundaries of clinical psychiatry nor the limits of the narrower professional conventions imposed on the discipline. He represents, I like to believe, the future of the discipline in our part of the world, at a time when violence is becoming endemic, predictable, and thoroughly institutionalized as a part of the process of modernization. At this moment of brutalization of our societies, the psychological sciences in South Asia are today richer, better equipped, and potentially more self-reflexive by virtue of the presence of this intrepid researcher from Sri Lanka. He has shown that there may still be some life in psychiatry as a critical social discipline in South Asia.
The following pages should be read not only as a scientific monograph on mass violence in some distant land but also as a disciplinary testimony on what we ourselves have done to our part of the world and what the world has done to us. It is a document of its time, and I commend it to all of us for careful reading and reflection.
Ashis Nandy is an Indian political psychologist, social theorist, and critic, known for his work on postcolonialism, culture, and the intersection of psychology and politics. His influential writings challenge dominant narratives, exploring the effects of colonialism, development, and modernity on society.
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