Commentry on Rebuilding community resilience in a post-war context: developing insight and recommendations – a qualitative study in Northern Sri Lanka, published by the International Journal of Mental Health Systems.

How can traumatized people recover when individual ‘talking therapy’ isn’t always possible because of a lack of availability? And when a significant proportion of the population is suffering from the adverse effects of traumas that almost the entire population was subjected to to some degree? This is the situation which often results from civil war, mass natural disasters like the Asian tsunami and military/political oppression by a previous or current government.

North and East Sri Lanka has experienced all of these, and the political/military oppression continues – is it safe, or even possible to speak about trauma at the hands of the authorities when still oppressed at the hands of the same individuals/group? In these circumstances would disclosure put victims/survivors and professionals at serious risk?

Added to this are practical consequences for internally displaced populations (IDPs) including loss of employment, physical disability from war injuries, the break up of communities and extended families, some still unable to return to their home, and some of those able to return finding their homes and buildings destroyed, and cultivated land damaged.

The consequences go way beyond the direct effects of trauma and negatively affect social environments, indirectly leading to greater amounts of interpersonal trauma including violence, domestic and child abuse. The This is a summary of events in Sri Lanka and their mental health consequences:

Individuals, families and communities in Sri Lanka, particularly in the North, the East and so called border areas of Sri Lanka, have undergone twenty five years of war trauma, multiple displacements, injury, detentions, torture, and loss of family, kin, friends, homes, employment and other valued resources [7]. In addition to widespread individual mental health consequences [82,83], such as PTSD (13%), anxiety (49%) and depression (42%) in the recent Vanni IDP’s [84]; families and communities have been uprooted from familiar and traditional ecological contexts such as ways of life, villages, relationships, connectedness, social capital, structures and institutions[85]. The results are termed collective trauma which has resulted in tearing of the social fabric, lack of social cohesion, disconnection, mistrust, hopelessness, dependency, lack of motivation, powerlessness and despondency. The social disorganization led to unpredictability, low efficacy, low social control of anti-social behavior patterns and high emigration which in turn causes breakdown of social norms, anomie, learned helplessness, thwarted aspirations, low self-esteem, and insecurity. Social pathologies like substance abuse, violence, gender based- and child- abuse have increased.

The authors in this report state that collective trauma does not fit the model of PTSD:

“modern psychology and psychiatry as it has developed has had a western medical illness model perspective that is primarily individualistic in orientation[11]”. With many people in the area believing that counseling and psychosocial interventions are not allowed, the authors consider different community-based interventions, the value of traditional, cultural rituals in healing trauma and culturally appropriate ways to improve the mental health within the population.

The report also considers what is increasingly called Posttraumatic Growth – the positive adaptive changes and resistance shown, and makes recommendations for affecting the effects of such widespread trauma.

Read the full research paper: http://www.ijmhs.com/content/7/1/3

Warning: distressing experiences are described including suicide methods.

Research by Daya Somasundaram and Sambasivamoorthy Sivayokan.

Citation:

International Journal of Mental Health Systems 2013, 7:3 doi:10.1186/1752-4458-7-3 http://www.ijmhs.com/content/7/1/3

Copyright

The authors have stated that this article is published under a Creative Commons Attribution 4.0 license, which allows anyone to share or build upon it without charge.

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