The term PTSD (Post-traumatic Stress Disorder) was new to Sri Lanka until the Eelam War broke out. The armed conflict that erupted between the government forces and the LTTE (The Liberation Tigers of Tamil Eelam)   changed the Sri Lankan society in many ways. The Eelam War created a collective trauma. The war caused lasting symptoms of paralyzing anxiety, grief, and hopelessness among the victims. People became acquainted with new terms that have been associated with war, armed conflict and trauma. PTSD was one of the terms (acronyms rather) that emerged during the course of war.

The armed clashes in Sri Lanka dates back to as far as 1972. In 1972, a group of undercover Tamil militants planted several bombs at the   Duraiappah Stadium in Jaffna.

The Eelam War started in 1983 and lasted until 2009. Over the years, the Sri Lankans saw a bloody war that destroyed thousands of lives. Many civilians as well as the members of the armed forces became the physical and psychological casualties of the war.

From Independence in 1948 to until 1971, Sri Lanka had a relatively small Army that was less professional and regarded as a ceremonial army.  With the 1971 JVP insurgency, the Armed Forces had been mobilized for combat operations for the first time. The Northern conflict demanded more manpower to the Armed Forces. In late 1987, the army had a total estimated strength of 40,000 troops, about evenly divided between regular army personnel and reservists on active duty. In the year 1986, the Sri Lanka Army had 30,000 personnel.  By 2008, the Sri Lanka Army had force strength of 162,000.

From 1981, the LTTE intensified its attacks on the security forces. In 1983, the LTTE ambushed a Sri Lanka Army patrol killing 13 soldiers.  The LTTE launched its first suicide attack in 1987 at the Sri Lanka Army camp in Nelliady killing 40 soldiers.

The Sri Lankan Armed Forces launched a number of military operations against the Tamil Tigers. On May 26th  1987 the Operation Liberation (Vadamarachchi Operation) was launched against the LTTE. With the military conflict the number of battle casualties increased on both sides. Sri Lanka Army Medical Corps (SLAMC) treated the Army casualties.

The psychological wounds of the Eelam War never became a priority. From the beginning of the Eelam War in 1983 to its end in 2009, the Sri Lanka Army did not have a single Military Psychologist to treat, evaluate or assess the mental health problems of the soldiers who faced a noxious war.

Many military leaders had no specific idea about the psychological traumatic reactions of the Eelam War although there were brilliant officers who had exceptional skills in military strategy. The psychological shock that surfaced with the war was not recognized efficiently in the early days of the conflict. Sometimes these reactions were disregarded or suppressed as acts of cowardice or acts of indiscipline. A few Officers who had profoundly read about the Vietnam War suspected possible Vietnam Syndrome appearing in the Northern war front.

The Clinical Community was divided. Some openly argued that there was no such condition as PTSD or combat trauma. Some stated that the PTSD is highly culture specific and it has nothing to do with the Sri Lankan combatants. The doctors began noticing unusual reactions among the combatants as well as the civilians who experienced traumatic combat events.  The victims had reminiscences of the traumatic events, nightmares, flashbacks, fear feelings and various other symptoms. In 1978, a medical practitioner of Negombo wrote:
A constable returned from Jaffna has unusual fears about Tiger gunmen who did several killings in the North. He became extremely frightened after hearing Inspector Bastianpillai’s death. He is unable to sleep and has nightmares about gunmen who travel by bicycles and shooting the Policemen in Jaffna. He is imploring a transfer to his hometown in Tangalle. In my opinion, he is unfit to serve.

There were many psychological reactions related to the armed conflict in the North. In the early days of the War (1984) one Lieutenant of the Sri Lanka Light Infantry serving in Jaffna noticed irritability, fatigability, lack of appetite and mood swings among some of his platoon members. After many years, he described the situation as tense and intolerable.

“After duty, going to the officer’s mess   to have   drinks became a routine. The officers were distressed after the Tinneveli attack that killed 13 soldiers of the Gurunagar camp. Although precautions were taken, we did not feel safe at the camp.  I slept with a gun under my pillow and a few grenades within easy reach.”
In 1985, the Tamil Tigers opened fire indiscriminately with automatic weapons killing and wounding hundreds of civilians in Anuradhapura.

A large number of psychological casualties have been reported among the civil population in the North. Professor Daya Somasundaram of the University of Jaffna took major initiative to identify and treat the war victims. His 1998 publication Scarred Minds was an eye-opener and is narrated by the victims diagnosed with PTSD. Henceforth, the clinical community started debating on PTSD in Sri Lanka.

What is PTSD ?
PTSD or Post-traumatic Stress Disorder is a cluster of psychological Symptoms that can follow a psychologically distressing event. The typical symptoms of PTSD occur after recognizable stress or traumatic event that involved intense fear and horror. PTSD denotes an intense prolonged and sometimes delayed reaction to an extremely stressful event.

The diagnosis of PTSD first appeared in 1980 in the DSM or Diagnostic and Statistical Manual of Mental Disorders.   According to the DSM -4    PTSD has been described as an Anxiety Disorder and the  essential feature of Post-traumatic Stress Disorder is the development of characteristic symptoms following exposure to an extreme traumatic stressor involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one’s physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate.

Traumatic events
Post-traumatic stress disorder is marked by clear biological changes as well as psychological symptoms.  These symptoms can impair the sufferer’s daily life massively.  It is associated with impairment of the person’s ability to function in social or family life including occupational instability, cognitive problems, marital problems and difficulties in parenting.

1971 insurrection
The 1971 uprising that was led by the JVP or the People’s Liberation Front made an unsuccessful attempt to overthrow the Government by launching an island-wide attack of the Police stations. According to K.M. de Silva a renowned historian 1971 JVP insurrection perhaps, the biggest revolt by young people in any part of the world in recorded history.

1983 communal riots
In July 1983, communal riots broke out following   the ambush and killing of 13 Sri Lankan Army soldiers including Lt Vass Gunawardana in Tinnevely Jaffna. Soon after this incident, the mob attacked the Tamil civilians killing and   looting their property. The communal riots in 1983 created a massive collective trauma.

Tsunami disaster
2004 December 26th Tsunami disaster was the immense natural disaster faced by Sri Lankans in its recent history. Over 30,000 people lost their lives and nearly 545,715 people became displaced. Tsunami 2004 created a deep psychological impact on the affected population. It was found that 3 to 4 weeks after the tsunami disaster in Sri Lanka 14% to 39% of children had PTSD and in another study, 41% of adolescents and approximately 20% of those adolescents’ mothers had PTSD 4 months after the event. (The Psychological Impact of the 2004 Tsunami- Dr. Matthew Tull -University of Massachusetts)

30 year war in Sri Lanka
Sri Lankan conflict was one of the longest armed conflicts of the 20th centaury. Sri Lankan society was shattered by hate and brutalization as a result of the internal war which caused over 95,000 lives and destruction of property worth over billions. This prolonged conflict generated massive numbers of PTSD victims.
The civilians of the Northern Sri Lanka witnessed the War in firsthand. Many became the victims of the collateral damages. Prof Daya Somasundaram in the  Journal of Mental Health Systems 2007 estimates that  14% of the Tamil population living in the Northern Sri Lanka suffer from PTSD.

Based on our rough estimations 8 percent – 12 percent of combatants are severely affected by combat stress and many of them are not under any type of treatment.

This may be the tip of the iceberg that is visible yet. This sample was referred to the Military Hospital Colombo for various psychiatric as well as stress and anxiety related conditions.

Although this was not a randomly selected field sample it includes combatants who were exposed prolonged combat trauma.

The American Psychiatric Association (2000) discusses risk factors that affect the likelihood of developing PTSD. Among the risk factors the severity, duration, and proximity of an individual’s exposure to the traumatic event are the most important factors affecting the likelihood of developing this disorder.

Even though the Eelam War was over by 2009, the psychological aftermath of the war has not ceased. Today we see the psychological reverberations of the Eelam War in our society.

Murders, suicides, rapes and child abuses, elements of social unrest, religious fundamentalism, inter-ethnic / religious tensions etc. have been increased over the past few years. There is a sense of alienation; mistrust and culture of silence prevailing in the post war Sri Lankan society. The psychological aftermath of the Eelam war is detrimentally affecting people and it would impact future generations unless we take appropriate measures to heal the Nation.