Collective Trauma: The Case for a

Multi-Level Social-Ecological Perspective

Daya Somasundaram
University of Jaffna

Abstract
Background
Complex ecological emergencies that follow war and natural disasters have a
psychosocial impact on not only the individual but also on the family, community and
society. Just as the mental health effects on the individual psyche can result in non
pathological distress as well as a variety of psychiatric disorders; massive and
widespread trauma and loss can impact on family and social processes as well as the
collective unconscious causing changes at the family, community and societal levels.

Method
This ecological study used qualitative methods of Participatory Action Research in
Cambodia and Northern Sri Lanka, while actively involved in psychosocial and
community mental health programmes among the Tamil and Khmer communities.
Participatory observation, key informant Interviews and focus group discussion with
community level relief and rehabilitation workers and i officials were used to gather
data. The effects on the community of the chronic, man made disaster called war was
compared to the more acute, natural disaster due to the tsunami in Northern Sri Lanka.

Results
Fundamental changes in the functioning of the family and the community were
observed. While the changes after the tsunami were not so prominent, the chronic war
situation caused more fundamental developments. At the family level, the dynamics
of single headed families, lack of trust among members, and changes in significant
relationships (mother-child), and child rearing practices were seen. Communities
tended to be more dependent, passive, silent, without leadership, mistrustful, and
suspicious. Additional adverse effects included the breakdown in traditional
structures, institutions and familiar ways of life, and deterioration in social norms and
ethics.

Conclusions
Exposure to conflict, war and disaster situations impact on fundamental family and
community dynamics resulting in changes at a collective level. Relief, rehabilitation
and development programmes to be effective will need to address the problem of
collective trauma, particularly using integrated multi-level approaches.

Key words
Trauma, Community, Collective Trauma, Disasters, War, Ecological model

1
 Background
Disasters, whether natural or man-made, are now well known to cause a
variety of psychological and psychiatric sequelae. These could range from adaptive
and constructive coping responses in the face of catastrophic events to understandable
non-pathological distress as well as a number of recognizable psychiatric disorders.
Conditions like Acute Stress Reaction (the old Disaster syndrome), PTSD,
Depression, Anxiety, Somatoform disorders, Alcohol and Drugs Abuse, and in the
long term, Enduring Personality Changes or DESNOS have been shown to occur after
disasters (De Jong et al, 2005). Evidence based and effective treatments and
interventions like CBT and Pharmacotherapy for PTSD to help individuals affected
by the trauma of disasters to recover are now available (Davidson et al, 1993)

However, there is less recognition or understanding of the effects disasters

have at the supra-individual levels as well as about appropriate interventions at these
levels. There are many reasons for this relative deficiency. The field of disaster
studies is rather recent. For example the diagnosis of PTSD was accepted only in
1983 with the DSM III.

Secondly, modern psychology and psychiatry have had a western scientific,

medical illness model perspective that is exclusively individualistic in orientation (De
Jong, 2006). However, it is being increasingly recognized generally that we need to
go beyond to the family, group, village, community and social levels if we are to more
fully understand what is going on in the individual, whether it be his/her development,
behaviour, emotion, cognition 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.

This broader, holistic perspective becomes paramount in non-western cultures

which have traditionally been family and community oriented, the individual tending
to become submerged in the wider concerns (De Jong, 2006). 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. Thus the family tends to think, feel, experience and respond
together. When an event happens, the family faces it together as a unit. They share the
experience and perceive the event in a particular way. Thus it may be more
appropriate to talk in terms of family dynamics rather than of individual personalities.
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. 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 the their daily life. In the Tamil tradition, a person’s
identity was defined to a large extent by their village or uur of origin (Daniel, 1984).
Their uur more or less placed the person in a particular matrix.

A better understanding of this reality can be sought through the ecological

model of Bronfenbrenner (1979) with the micro, meso, exo and macro systems or the
individual nested in the family nested in the community (Hobfoll, 1998; Dalton, Elias

2
& Wandersman, 2007). The WHO definition of health also emphasis the need to look
beyond the individual level:
"Health is a state of complete physical, mental, (family) 1, social and (spiritual)1
well-being, and not merely an absence of disease or infirmity".
- World Health Organisation (WHO)

Table 1 Dimensions of Health- (Some examples)

Dimensions of Diagnosis
Causes Symptoms Interventions
Health
Physical injury Physical illness, Drugs treatment,
Pain, fever, Psychosomtic, Physiotherapy,
Physical Infections Somatoform Relaxation
Somatization
Epidemics disorders techniques, massage
ASR, PTSD, Psychological
Shock
Anxiety, First aid,
Stress
Tension, fear, Depression, Psychotherapy,
Psychological Fear- Terror
sadness Alcohol & Counselling,
Loss
Drug abuse Relaxation
Trauma
techniques, CBT
Death Vacuum Family Family Therapy
Family Separation Disharmony Pathology, Marital Therapy
Disability Violence Scapegoat Family Support
Parasuicide,
Suicide,
Unemployment, conflict, suicidal Group Therapy,
Social Violence,
Poverty, war ideation, anomie Rehabilitation
collective
trauma
Misfortune, bad Despair, Possession, Logotherapy, rituals,
traditional healing,
period, spirits, Demoralization,
Spiritual Meditation,
angry gods, evil Loss of belief, Contemplation,
spells, Karma Loss of hope Mindfulness

This study grew out of the experience of working in three disaster, post-
disaster contexts: man made disaster called war and the 2004 Asian Tsunami in
Northern Sri Lanka and post war recovery and rehabilitation process in Cambodia.
The impact of these catastrophic events on the individual was quite clear
(Somasundaram, 1998; Somasundaram et al, 1999). There were some observations on
the family level (Jeyanthy et al., 1993). However, it was when it came to implementing
community mental health programmes that the impact on the community became
evident. Simple interventions at the individual level were not sufficient. The problems
at the community level had to understood and addressed if the individuals were to be
helped. Further families and communities had to be helped to recover if any
meaningful socio-economic rehabilitation rebuilding programmes were to succeed. In
fact, in time most long-term programmes began to include a community based
psychosocial component within the larger socio-economic rehabilitation and
1
The family level is added for reasons given in the text. The family unit is paramount in most parts of
the traditional world. The family tends to think and act as a unit. When the family is affected, the
members too are affected, while if the family is healthy the individual is either health or recovers
within the family setting. The spiritual level has been put forward at various WHO forums but has
apparently been vetoed by the Chinese for internal political reasons.

3
rebuilding. Previous workers had already drawn attention to the community level
problems caused by disasters. Kai Erikson (1976) called the disruption of social
networks following the Buffalo Creek disaster in the US ‘loss of communality’.
Eisenbruch (1991) described the loss of cultural traditions and rituals in Indochinese
refugees in the US as ‘cultural bereavement’ and Somasundaram (1996) to
collective trauma. More recently a number of discerning workers in the field have
been drawing attention to the importance of looking at the family (Landau & Saul,
2006) and cultural dimension (Joop, 2002; Miller & Rasco, 2005; Silove, Steel &
Psychol, 2006; Landau & Saul, 2006) following disasters.

Looking at some examples from Australia, Parker (1977) mentioned the

psychosocial and ‘relocation stressor’ following the Cyclone Tracy in Darwin linking
it to the ‘socio-cultural needs for societal integration and stability’. Nadew (2006) in
his survey of psychosocial and mental health problems among the aboriginal or
indigenous population found a very high prevalence of conditions like PTSD (55 %),
Depression (22%), alcohol and drug abuse (73 %), and violence. He linked it to the
long-term and massive trauma suffered by the aboriginal population. The National
Strategic Framework for Aboriginal and Torres Strait Islander Health (2003) states:

“The sense of grief and loss experienced by generations of Aboriginal and

Torres Strait Islander peoples in relation to dispossession, to the disruption of
culture, family and community and to the legislated removal of children has
contributed to ongoing problems in emotional, spiritual, cultural and social well-
being for Aboriginal and Torres Strait Islander individuals, families and
communities.”

The high incidence of mental health problems, alcohol and drug abuse,
physical and sexual violence, family disharmony can be the result of the break up of
traditional culture, way of life and belief systems. Indeed, Watson (2006), a proudly
aboriginal but western trained psychiatrist himself, attributes the loss of the
indigenous cultural identity to the cultural breakdown. Isn’t the current social
pathology so widely seen in the indigenous community of lore (as in many parts of
the world) due to the collective trauma they have undergone? Would the best way to
approach this massive problem be through providing the currently recommended CBT
and SSRI’s to the large number of affected individuals or would be the more effective
and feasible way be to attempt to rebuild and restore family and community
structures, values, beliefs, identity and way of life?
Borrowing from the individual psychopathological descriptions, the term
collective trauma is being introduced in this study in a metaphorical sense to represent
the negative impact at the collective level, that is on the social processes, networks,
relationships, institutions, functions, dynamics, practices capital and resources; to the
wounding and injury to the social fabric. Jung’s concept of the collective unconscious
(Jung, 1954) is used to metaphorically denote repository of the mass scale impact of
major catastrophic events on the collective mind, the collective memory. The long
lasting impression or scar in the social fabric would then result in the sociopathic
changes that can be called collective trauma.

4
 Method
This qualitative, ecological study is a naturalistic, psychiatric ethnography
(Osterman & de Jong, 2006) using Participatory Action Research techniques in four
contexts: The main focus is on the ongoing chronic civil war situation from 1983
onwards contrasted to the pre-war and post Dec. 2004 Tsunami recovery effort in
Northern Sri Lanka and the post war rehabilitation in Cambodia in the 1996-98
period2. The ecological study follows Bronfenbrenner (1979):
“an effort to investigate the progressive accommodation between the growing
human organism and its environment through systematic contrast between two or
more environmental systems or their structural components, with a careful attempt to
control other sources of influence either by random assignment (planned experiment)
or my matching )natural experiment)…. There are instances in which a design
exploiting an experiment of nature proves a more critical contrast, insures greater
objectivity, and permits more precise and theoretically significant inferences- in
short, is more elegant and constitutes “harder” science- than the best possible
contrived experiment addressed to the same research question.”

Participant Observation, in depth case studies, key informant interviews and

focus group3 discussions as well as several quantitative, individualistic psychosocial
and mental health surveys published elsewhere (Somasundaram, 1998;
Somasundaram & Sivayokan, 1994; Somasundaram, 2001 ; Somasundaram et al,
1999; De Jong et al, 2001) provided the data for the study. The author had the unique
experience of working as a mental health professional I these settings. Though being
an Asian, ethnic Tamil, the author had most his education and professional training
abroad, particularly in the west, thus providing both an ‘insiders’ and ‘outsiders’ view
point. In terms of conflict of interest, the author subscribes to a pacifist persuasion,
contrasting with the militant/military fervour of the authorities in power. This has
added a considerable targeted risk factor, particularly in Northern Sri Lanka, apart
from the general uncertainties (terror) of these contexts.
The main purpose of this study is an attempt to phenomenologically describe
and understand the familial and societal factors involved so as to better design and
implement more effective, appropriate and workable interventions, policies and
programmes in a post-disaster context.

Results & Discussion

Individual
Several surveys of individual level trauma and its effects in the three contexts
of war & post tsunami in North Sri Lanka and post war Cambodia have shown
widespread traumatisation and considerable psychosocial sequelae in the different
population groups (approximately 20-30% PTSD ) (Somasundaram & Sivayokan,
1994; De Jong et al, 2001). A more recent epidemiological survey (Vivo, 2003)
carried out in the Vanni, an area in the north of Sri Lanka, found that 92% of primary
school children had been exposed to potentially terrorizing experiences including
combat, shelling, and witnessing the death of loved ones. In 57% of the children, the
2
which included an attempted coup and some military skirmishes.
3
These have included group discussion from the community, village levels, local governmental (G.S.-
village headman, teachers, etc.) workers; displaced camp, relief workers; District (GA- District
Authority, NGO, militant) committees; National (Health Ministry, Presidential Task force); and
International (INGO’s, UN) groups that discussed and debated mental health and psychosocial issues.

5
effects of these experiences were interfering considerably with their daily life (e.g.,
social withdrawal and weakening school performance). About 25% were found to
suffer from PTSD.
Apart for the individual suffering and disability this entails, such a large
prevalence with recognizable psychiatric disorders in a population would lead to a
cumulative effect that would cause considerable social pathology and dysfunction.
However, in this abnormal situation many of the reactions, which would be
considered pathological in normal times, would become the norm. A normal reaction
to an abnormal situation. Thus many with so called diagnosable psychiatric disorder
like those who would be identified in population surveys, may not seek help, at least
western psychiatric help. This is clearly shown in the low percentage of PTSD and
similar post trauma syndromes in psychiatric out patient services ( approximately
5%). Some were seeking help through other avenues such as the traditional sector or
general health care facilities with somatic complaints (Somasundaram, 2001) or more
traditional idioms of distress like Perumuchu in the Tamil and Kit Chraen in Khmer
communities. An important contentious issue is whether those diagnosed as having
psychiatric disorder using western categories are in fact having a mental illness. The
person, his/her family and community often did not recognize or accept a psychiatric
disorder. In fact the person often functioned relatively well for that context. A further
contentious issue is how effective or appropriate is western treatments like
psychopharmacotherapy or state of the art CBT even in those with manifest
dysfunction. In Northern Sri Lanka and Cambodia, CBT was not possible as there
were no trained therapists. Even the psychopharmacological agents, SSRI’s, were not
widely available. Nevertheless, our experience in Northern Sri Lanka and Cambodia
was that a small minority with more severe dysfunction do benefit from western
psychiatric treatments. Their improvement also helps their families, communities and
refugee camps where they lived. Indeed, community mental health programmes that
do not include the possibility of addressing the problems of those with severe mental
disorders would fail in the eyes of the community and cause a breakdown in the
smooth functioning of the setting where they were. However, it was not feasible to
treat the large numbers discovered to have psychiatric disorders with western
psychiatric treatment. Rather a community based programme to rebuild the damaged
family units and social structures, networks, resources and relationships encourage
re-establishment of traditional rituals and practices; group meetings and functions, in
short to start the community working again appeared to be more judicious. When the
family and community regained their function, individuals recovered their confidence,
motivation, capacity and skills.

Family
The war and the tsunami had a major impact on the functioning family system.
From the loss of one or both parents, separations and traumatization in one member,
pathological family dynamics can adversely affect each member, particularly the
children.

The traditional family unit as the basic social institution has barely survived
but its function has been irrevocably changed by the chronic conflict. The
cohesiveness and traditional relationships are no longer the same. Compared to before
the war, it is a common complaint as well observable socially that children no longer
respect or listen to their elders, including teachers. Children are now socialized in a
war milieu with direct experiences of violence, emotions of terror, grief and hatred

6
and militant role models. A subtle influence has been the way elders have been treated
by the authorities and the submissive way they have responded. One example that was
communicated to me by a foreign NGO worker is the common day to day occurrence
at the pervasive check points in the North and East. Tamil parents quickly change
their behaviour and tone (in contrast to what the child has seen at home or elsewhere)
when dealing with the security forces. They, perhaps unconsciously and with the best
of intentions (to safeguard their children and to avoid unnecessary hassle), assume a
submissive posture (removal of hat, bent head and body, low and almost pleading
tone of voice, pleasing manner with a wide grin etc.) when accustomed by the security
forces (e.g. at check points). The children will observe this change without
comprehending the full purpose (perhaps to avoid the child being detained) and in
time develop contempt for his or her parents. Elders are perceived as being powerless
and incompetent in dealing with war and its consequences.

In Cambodia, during the Khmer Rouge reign, mistrust and suspicion among
family members were created by having the children report on their parents. The
essential unity and security within the family system was broken. Even though the
situation never became so bad in N. S.L., parents were careful about what they
discussed in front of their children as the child could inadvertently let this out in
school, particularly if it was something against the Tamil militants.
Due to the peculiarities of the war, males were more often targeted and were at
high risk to be killed, arrested, detained , disappeared, join the militancy or to migrate.
For example in the small fishing village of Savatkaddu, where we set up a widow’s
group, there were 180 widows, many of whose husbands were killed at sea, a highly
contested area between the Sri Lanka Navy and the Tamil militants. Altogether there
are 19,090 female headed households in Jaffna. The greatest majority are widows who
have lost their husbands due to the war. The effect on the family, the widow
(Kumerandran et al., 1998) and the children has been immense. The loss of one
member of the household, particularly the breadwinner has a marked impact on the
family dynamics. Absence of members of the family due to death, injury or
displacement will create infallible gaps in the functioning of the family unit. The
uncertainty or grief about the missing member will add to the maladaptive family
dynamics that will ensue. The loss of the essential unifying role of the missing
member can cause disruption and disharmony within the family. A common situation
is where the father has been detained, ‘disappeared’ or killed but the family members are
not sure of his fate. They are caught in a `conspiracy of silence' where further inquiries
may lead to more problems for the father were he still alive and the mother may not be
able to share the truth with the child. The family itself often becomes ostracized by
society. The child then presents with behavioural problems. The mother has to adapt to
all the negative implications of being a 'widow' in this society. The role of the mother
has undergone momentous change with increasing non-traditional responsibilities,
activities and "liberation".
A more tragic situation happens when the disappearing is done by a local Tamil
militant group. Here the conspiracy of silence is much deeper. A disappearance by the
army or security forces is acceptable, even adds some prestige within the community.
But disappearance by their own Tamil militants is something the widow and her children
cannot talk about even in the community or inner family circle. Apart from the danger
and risk of repercussions, the disappeared is considered an undesirable, even a traitor.
Thus the widow cannot express her emotions at all, even to herself, the deception goes
much deeper into oneself. In a case that I was seeing, in time the widow was suppressing

7
the memory of her husband and he would soon really disappear from her consciousness
as well.
In 1996 there were reported to be 600 disappearances in Jaffna and in the current
period from Dec. 2005, there are 300 disappearances. A study involved the follow-up of
the families of the disappeared, assessment of needs and psychosocial support. When
entering the homes of the disappeared, the atmosphere was akin to a funeral house, even
years after the disappearance. The mildest of conversations linked to the disappeared,
would set off tears and crying. The home was not lively, it was quiet and moody. In the
case of the disappeared there is no closure of the death, no certainty about the fate of the
person. It would be disloyal to even consider that the person could have been killed.
A study assessed the impact of displacement in the North on functioning of the
family system (Jeyanthy et al., 1993). Psychological disturbances particularly depressive
symptoms were much more common in displaced families than in those living in their
own homes. In displaced children, separation anxiety was common as were cognitive
impairment, conduct disorders and sleep disturbances. Disturbances in family dynamics
particularly disputes and quarrelling between father and mother were attributed to
economic stress, lack of privacy and interference of others in over crowded camps. Other
war related trauma like torture and loss of a limb due to landmine injury had a direct
impact of families. Torture survivors who returned to their families often were not able
to function as before. They were socially withdrawn, had difficulties with intimate
relationships, were irritable and not motivated to work or be active. These situations
changed the family dynamics. In one case, there was a role reversal with the wife going
to work and the husband trying to cope with household chores. Due to his feelings of
inadequacy, he attempted suicide. The loss of a limb led to feelings of inferiority and
shame, that made family life difficult. In some cases, husbands left their wives. When a
family member develops a psychiatric disorder like PTSD, Depression or Substance
abuse due to traumatisation, the symptoms and social dysfunction has an adverse effect
on the family as well.
In the case of the tsunami, there were more women who died compared to men
as elsewhere (Oxfam, 2005). Perhaps the women were less capable of surviving, not
having the skills in the sea. Women may also have been home when the tsunami struck.
This left many male widows who found it difficult to cope with the remaining families,
not having the skills to look after children, prepare food etc. Some took to alcoholism.
Suicidal ideation, attempts and suicide was reported to be high. In time some re-married
creating problems for the children. Some problems were given to other relations to look
after. The attempts to adopt children who lost one or both parents or to put them in
institutions were resisted child protection authorities. Initially there had been reports of
abduction of orphans, so called tsunami babies. Thus in many ways the impact of the
tsunami on the family was unique.

Community
Disasters have an effect not only on individuals (Somasundaram, 1998), but
also on their family, extended family, group, community, village and wider society.
During civil conflicts, arbitrary detention, torture, massacres, extrajudicial killings,
disappearances, rape, forced displacements, bombing and shelling became common
(see Tables 1).

Distribution of War stress in the community

(Somasundaram & Sivayokan, 1994; Somasundaram, 2001)

8
 Stress factors. Community OPD
Direct stress (n = 98) (n=65)
Death of friend/relation 50% 46%
Loss to property 46% 55%
Injury to friend/relation 39% 48%
Experience of bombing/shelling/gunfire 37% 29%
Witness violence 26% 36%
Detention 15% 26%
Injury to body 10% 9%
Assault 10% 23%
Torture 1% 8%
Indirect stress
Economic difficulties 78% 85%
a
Displacement 70% 69%
Lack of food 56% 68%
Unemployment 45% 55%
b
Ill health 14% 29%
a
Before the 1995 mass displacement when the figure would have reached almost
100%
b
Ill health due to war related injuries including amputations due to landmine blasts,
epidemics like malaria, reduced resistance to infections (due to stress and
malnutrition), septicemia etc. had debilitating mental effect.

Whole communities or villages are targeted for total destruction, including

their way of life and their environment. According to Bracken, Petty and
Summerfield, in a SCF (1998) publication on the nature of current conflicts:
“ Civilians are no longer ‘incidental’ casualties but the direct targets of violence.
Mass terror becomes a deliberate strategy. Destruction of schools, houses,
religious buildings, fields and crops as well as torture, rape and interment, become
commonplace. Modern warfare is concerned not only to destroy life, but also ways
of life. It targets social and cultural institutions and deliberately aims to undermine
the means whereby people endure and recover from the suffering of war… A key
element of modern political violence is the creation of states of terror to penetrate
the entire fabric of economic, sociocultural and political relations as a means of
social control.”
The civil war in Northern Sri Lanka has had a tremendous impact on village
traditions, structures and institutions that had been the foundations and framework for
the their daily life causing fundamental, irrevocable change in these processes
(Council of NGO’s, 1998; National Peace Council & Marga, 2001). Good examples
are the systemic attacks on all the Tamil villages in the Trincomalee District which
eventually displaced all of them into the city or to other districts. Another example is
the forced eviction in the early 1990’s, of the Moslems of the North within 48 hours
many of whom still languish in refugee camps in the South. Apart from direct attacks,
whole villages of all three communities have been disrupted, displaced and uprooted
due to the ongoing conflict. Examples are the fishing community, another the farmers.
From the beginning, for alleged security reasons, fishing in the North and East has
been restricted. This has included ban on fishing in large areas, restrictions on

9
distance where fishing can be done (usually restricted to short distance offshore).
Whole fishing communities have been displaced, such as from Myeliddy from early
1990’s. The displaced families from these communities can be found languishing in a
number of refugee camps around the Jaffna in Peninsula or several families occupying
makeshift accommodation. Inter and intra family conflict is rife with the once active
fishing folk can be observed to be despondent and hopeless. As already mentioned,
fisherman have also been at increased risk to death, disappearance, detention, injury
etc. due to the nature of their work which takes them into the sea, a highly contested
area in the war. As a result the highest number of widows are from this community.
This has had a terrible toll on this community. Many have shifted to other
occupations, some are still unemployed living off government rations, others have left
the area. They have lost their way of life and culture. Many yearn for the days when
they were able to fish freely and lead a fisherman life in their village. They often
report dreams of living in their old houses and going fishing in the sea. Before 1983,
fishing was a very fruitful occupation, the catch was good off the long North East
coast, and a considerable part of the fish was transported to Colombo and other areas
in the Island. In the whole island the North East was a leading area for fishing. The
coastal communities were thriving hives of activity.
With the ceasefire in 2002, many of fishing families had returned to the coast
which were not restricted for security reasons4 and restarted their fishing activities
step by step5. When the tsunami struck in Dec.2004, all this was again destroyed. The
sea had been a vital and intimate part of their life. There was a strong organic bond.
The sea was called the ‘mother’ in Tamil in their folk songs, narratives, literature and
common parlance. When the sea rose from her bowels and struck with such
destructive furore, a fundamental, organic bond was broken. In the early days after
the Tsunami most of the fisherman vowed never to go back to the sea. Many of their
songs and discourse of this time expressed this loss, grief and feelings of being
abandoned by the mother, rebuked and punished. The slow mending of this organic
relationship took time. Eventually most fisherman returned to fishing, families slowly
moved closer the sea from where they had initially been displaced and then feared
returning to. Community mental health programmes worked on reducing this fear (by
various desensitisation techniques) and encouraged the return to fishing. The
resumption of conflict has displaced many of these communities again. Significantly,
the recent disappearances and extrajudicial killings have targeted the leaders of the
fishing organizations who had become effective socio-politically in working for the
betterment of their community.
It has been a similar tale with farmers, many of whom have been displaced
from their traditional lands, and have lost all their equipment. Some are unable to
cultivate their land, as it is located in contested areas or are mined. Some have
abandoned their traditional occupation as it no longer profitable, given unavailability
or cost of agricultural inputs like fertilizers, insecticides, fuel etc or lack of access to
markets for their product. The ubiquitous presence of buried landmines creates a
pervasive apprehension in the back of the minds of people, making them ever vigilant,
cautious about walking freely on the land, afraid of putting a wrong foot somewhere.
4
There was considerable political activity among the fishing community. Organizations representing
the fisherman sought for increasing access to the sea (confronting the SL Navy and authorities) and
more resources.
5
Starting first with shore fishing, they slowly started venturing further into the sea, progressively using
more powerful boats with motors (starting with wooden canoes, sail and then motor). In time there was
competition with Indian fisherman who had slowly started to intrude into their ‘territory’ which had
been abandoned for a long time.

10
Some developed nightmares of being the victim of an exploding landmine. The once
beloved land itself becomes polluted, a source of terror (Gunaratnam et al., 2003).
Other traditional trades like carpenters, masons and so on have been affected
similarly. The Moslems who were a very prosperous business community as well as
specialized in other occupations like tailoring, tinkering, leather work and so on have
lost their occupations and way of life due to their forced eviction. They had tried
tentatively to return after the 2002 ceasefire but never felt secure or reassured. With
the resumption of hostilities, they have again left. The Sinhalese were well known
bakers in the North and East, but have now all left.
As already mentioned in the various rural communities, the village or uur, was
the secure and familiar environment with traditional way of life, supportive social
structures, institutions and functioning. With the disasters, both the war and tsunami,
some villages have ceased to exist. Due to dislocation people have been separated so
that the network of relationships, structures and institutions have been lost. Kai
Erikson (1976) described it as a “loss of communality”. A very good example of the
collective effect of displacement was the mass exodus from Valikamam in 1995 of an
estimated 400,000 people within 24-48 hours. Even when people have returned to
their villages, as it has happened in Jaffna in 1996, the village was not the same.
Many were complete newcomers. The old structures and institutions were no longer
functioning. Thus the protective environment (Kai Erikson’s membrane) provided by
the uur is no longer there.
Similarly, in the life of Tamils, their house (veedu) is very important. There
will be a history of the house. The ancestral relations who are dead, will continue to
have connections with the house. They will be remembered and considered as if they
were present in the house, especially when rituals are performed in the house. There is
a Tamil tradition of being loyal to the house. If one makes a big mistake, he feels
guilty of having betrayed his house. There is a biological link between the house and
the people who are dwelling in the house. When one is in the house, or when he or she
come from outside into the house or when they are away from the house and think of
the house, they feel security and peace (like a baby in the womb). When they leave
the house for long periods, this biological link breaks. This affects the mental
condition in several ways. People believe that Ghosts or demons will occupy the
houses which are left alone, unoccupied for a long time. Repeated displacements
which have affected almost everyone at one time or another have forced the Tamils to
abandon their homes. The 1996 displacement was a mass exodus that affected
everyone. People who returned to their houses after displacement, felt there was a
change in the organic bond. They could not re-establish the relationship with their
houses. Many have left their houses in a state of disrepair6, occupying a part of the
house with makeshift arrangement, ever in the ready with an emergency bag ready to
move.

Some catastrophic events were of such a scale that it left an imprint on

everyone, it changed the lives of individuals, their families and their communities in
fundamental ways, the experience passed on into the collective memory to become
part of the narratives and stories, to influence future generations through subtle social
processes so that it maybe appropriate to speak of an impact on the collective
unconscious. The mass exodus of 1996 was one such experience. Apart from the
forced breaking of the bonds with their homes and village, leaving in terror with few
possessions, the trek of over 400,000 people in the middle of night with rain and
6
On many previous occasions, they were seen to repair their houses.

11
shells, roads clogged with crowds, the slow movement step by step, the falling of the
less able, elderly by the wayside; final arrival in makeshift, inadequate
accommodation with very poor facilities or none at all, changed everyone. People lost
their identity, pride, dignity and hope.
Other major events having an impact on the collective unconscious were the
so called July, 1983 ethnic holocaust; the burning of the Jaffna public library just
prior to that (sometimes referred to as cultural genocide); the Indian operation to
capture Jaffna in Oct., 1987 (breaking a bond with another mother); and the tsunami
of Dec., 2004. Some phenomena seen during the war like ‘disappearances’, torture
and landmines, also had a long-term effect on the collective unconscious.
Noteworthy, in our community survey (Somasundaram & Sivayokan, 1994),
is the finding that 1% of the study population had been tortured, but the figure reached
8% in the OPD patients (Somasundaram, 2001). Torture was used as a routine
procedure carried out on all those detained (Doney, 1998). Torture developed into a
physical and psychosocial tool to break the individual personalities of those who try
to resist as well as an encompassing method to coerce a community into submission.
Many individuals did not survive torture, but those who did were released in a broken
condition; or when dead, their maimed bodies were conspicuously exhibited to act as a
warning to others. It became one aspect of institutionalized violence and laws were
passed, such as the Prevention of Terrorism Act and Emergency Regulations, which
facilitate prolonged incommunicado detention without charges or trial, in locations at
the discretion of the Security Forces, and allowing for the disposal of bodies of
victims without judicial inquiry. In turn, this legislation legitimizes the use of torture
and death in custody (Amnesty International, 1986). Thus torture became
institutionalised as an aspect of state terror as well as by the non-state actors as a tool
to control, to subjugate a community.
The long-term climate of terror, insecurity and uncertainty was a prominent
cause of the collective trauma due to the war but was not seen with the tsunami. The
natural disaster was a one off catastrophic event that left a trail of destruction and loss
but did not continue to exert a prolonged effect. As a result the severity of the
collective trauma was much less. In Cambodia the severity of the collective trauma
was much more as all social structures, institutions, family, educational and religious
orders were razed to ‘ground zero’ deliberately (so as to rebuild a just society anew!)
(Vickery, 1984). Both in N. Sri Lanka and Cambodia, people had been exposed to
multiple traumatic events (in N. SL the average was over 6 events) so much so that
the condition of complex or chronic traumatic stress maybe more appropriate (Straker,
1986). The Tsunami was an additional traumatic event on top of many more. Further
such indirect effects of disasters (Table 1) like displacement, unemployment, poverty,
ill health, malnutrition and socio-economic hardships could be as debilitating and
traumatic in its long term effect.
Another ecological factor that was a cause of collective trauma was the
breakdown in intersetting communication and knowledge (Bronfenbrenner, 1979)
between the mesosystem of the community and the macrosystem of those in authority.
Those in authority, the military, militants and the state, held all the power and failed
to communicate essential information. Apart from the language barrier between the
Sinhala state and the Tamil community, decisions and actions appeared arbitrary and
dictatorial. There was no genuine relationship or attempts to communicate except for
propaganda exercises that were obvious to civil society. The Tamil militants were also
careful not to allow any relationships to build up between the state, the military and
civil society. Any positive developments in that direction were dealt with harshly.

12
 The loss of leadership and the talented, skillful, resourceful persons, the
professional, technocrats, and entrepreneurs from the community has had devastating
consequences. Many have left over the years due to increasing difficulties, traumatic
experiences and social pressure from family and colleagues, the so called ‘brain
drain’. Those who remained have been targeted by those aspiring to rule the
community. The various authorities vying for the loyalty and subservience of the
community have ruthlessly eliminated what they have perceived as obstruction to
their power, control. Apart from the extrajudicial killings of the state and its allied
paramilitary forces, the internecine warfare among various Tamil militant
organizations competing for the loyalty of the community have resulted in the
assassination of many of its own ethnic civilians. A process of self-destruction, auto
genocide. Those with leadership qualities, those willing to challenge and argue, the
intellectuals, the dissenters and those with social motivation have been weeded out7.
They have either been intimidated into leaving, killed or made to fall silent. At these
shifts in power, recriminations, false accusations, revenge and retribution were very
common. For example, as it happened in 1987 (IPKF), 1990 (LTTE), 1996 (SLA) and
with a free for all currently after 2005 with the collapse of the ceasefire.
Bronfenbrenner (1979) warns of the destructive consequences to a society which
experiences the systematic degrading and debilitation of its richly talented members.
This is the loss of vital resources (Hobfoll, 1998), the destruction of social capital, the
nodal points of vibrant relationships and essential networks which is a prominent
cause of Collective Trauma. Without leadership and organization, vital networks and
working relationships have collapsed, leaving the community easy prey to competing
propaganda, authoritarian control and suppression. Gradually people have been made
very passive and submissive. These qualities have become part of the socialization
process, where children are now gradually taught to keep quiet, not to question or
challenge, accept the situation, as a too forward behaviour carries considerable risk.
The creative spirit, the vital capacity to rebuild and recover have been destroyed.

An important ingredient in the social recovery process is resource gain cycles

(Hobfoll, 1998). Unfortunately, after extreme stress the opposite occurs- rapid and
turbulent loss cycles (Hobfoll, 1998). Vicious spirals of loss are set in motion due to
cascading patterns of multiple stressors where the loss of one resource triggers other
losses ( Dalton, Elias & Wandersman, 2007). Hobfoll (1998) points out that ‘major
trauma cycles not only spirals for the individual in a personal sense with anxiety,
depression and loneliness, but also often result in reduced social involvement,
diminished interest in life and family feelings of social detachment and a sense of
alienation…Moreover, PTSD has a stress-contagion influence producing
psychological distress in loved ones…’ For example in the context of war in N. S.L.,
displaced communities had to first face the traumatic loss of loved ones, their homes,
village structures and relationships, witnessing horrifying events before being
compelled to flee to perceived safer havens but ending up in the crowded, refugee
camps with inadequate facilities. Here stressors of unemployment, malnutrition,
illness, socio-economic difficulties within an atmosphere of uncertainty and insecurity
compound their already precarious plight. The uprooting from the familiar village

7
‘Pullu Kalaithal’. Those eliminated are labeled as anti social elements or traitors. Those
targeted are perceived as being against them, or defying them. Often no one claims
responsibility but various rumours for the killing are set loose in the community. Bodies are
left conspicuously in public places as warning to others. The way these killings are reported in
the media adds to the general terror.

13
environment often meant loss of social support networks, traditional leadership,
rituals and practices. For community healing and recovery, this vicious cycle has to be
broken and a resource gain cycle instituted.

A more subtle change in the dynamics and social transformation that arise
from ecological transitions or shifts (Bronfenbrenner, 1979) from the civil, peace
context to a war context would result in change at cognitive, emotional and social
levels. In N. S.L., with the vicious spirals of resource loss, there was regression to
constriction of consciousness, narrowing of outlook and world views, and reduced
social cohesion with suspicion, mistrust and ennui. A marked preoccupation with
death as seen in popular media and less concern with the future was noticeable. An
attempt at recovery programmes will have to reverse these pernicious dynamics.

Social Justice
Another important casualty in this war has been the implicit faith in the world
order and justice in particular. The overriding experience of Tamils has been a
discriminatory system and injustice. Those responsible for what may be called war
crimes and the worst types of human rights abuses have never been punished. The
many cases of massacres, disappearances, torture, rape, custodial killings, mass
graves, including the very recent civilian massacres, that have been investigated and
brought to light have not resulted in justice being done. Impunity prevails. Much of
the violence has become structural and systemized into the very laws of the country
such as the Emergency Regulations and Prevention of Terrorism Act. Though
perpetrators have been identified, and in some rare cases arrested and court cases
instituted, none have been sentenced (the sole exemption being the highly publicized
Krishanthy case which was taken up by many women’s and other human rights
organizations), or punished (UTHR-J, 1999). The perpetrators are promoted, or they
are transferred out or sent on compulsory leave. Some have been rewarded with
prestigious posts like ambassadorships in Australia and Canada! In the case of
injustices by the Tamil militants, there is no social mechanism for redress, the victims
often have to bear it in silence.

Consequences of Collective Trauma

• Mistrust
• Suspicion
• “Conspiracy of Silence”
• Deterioration in morals and values
• Poor leadership
• Dependency
• Superficial and short term goals

14
Consequences of Collective Trauma

The cumulative effect of all these devastating events and social atmosphere on
the community can be described as collective trauma, which goes beyond the
individual. In fact, given the widespread nature of the traumatization due to war, the
psychosocial reactions in the individual may have come to be accepted as a normal
part of life. But at the community level, manifestations of the trauma can be seen in
the social processes and structures. This can be seen in the prevailing cultural coping
strategies. People have learned to survive under extraordinarily stressful conditions. A
UN official observed that in Jaffna people have become professional in dealing with
the situation from previous experiences. Every family has a bag packed with all the
essential items to live rough and important documents, ready to leave at a moments
notice. Once they are displaced to a camp, they are very systematic in getting
themselves organized. The immediately find a corner, hang up screens with sarees,
and start arranging their belongings for a stay. It should be also mentioned they are
now very adamant in obtaining, even demanding the dry rations and other relief items.
This ‘previous training’ came in handy after the Tsunami, where the displaced from
the Tamil community were found to cope much better than their Southern
counterparts. Many of the Tamil psychosocial training manuals that had been
developed over the years were translated into Sinhalese after the tsunami.

However, some coping strategies that may have had survival value during intense
conflict may become maladaptive during reconstruction and peace. For example, the
Tamil community had learned to be silent, none involved and stay in the background.
They have developed a deep suspicion and mistrust. For example the Tamil people
no longer trust the security forces, including the police. Their recent experiences have
taught them otherwise. Thus instead of trust, respect for law and order, a belief in
their legitimacy; there is fear, even terror. Thus when someone breaks the law, or
there is a robbery or some other illegal activity, no Tamil would naturally report it to
the Police. A recent example was the UNDP mine awareness programme where the
UNDP naively asked people, when they discover a mine, to report it to the local
security forces. People protested and the UNDP changed its policy. Similar paranoid
attitudes were found after the Sept. 9/11 attack in New York (Aber et al, 2004).

People have learned to simply attend to their immediate needs and survive to
the next day. Any involvement or participation carried considerable risk, particularly
at the frequent changes in those in power. The repeated displacements, disruption of
livelihood have made people dependent on handouts. People have lost their self-
reliance, earlier the hallmark of the Tamil. They have lost their motivation for
advancement, progress or betterment. There is a general sense of resignation to fate.
They have developed dependence on help from outside sources, on relief, on
handouts. Similar to ‘learned helplessness’, dependence hampers all rehabilitation
and development efforts. People no longer feel motivated to work, or better their lots.
Many prefer to continue to live in refugee camps refusing resettlement plans. Many
farmlands remain uncultivated.

Brutalization
Another collective phenomena due to the war has been the brutalization of
society. Apart from the militarization of all aspects of life and the pervasiveness of the

15
‘gun culture’, is the long-term effect on thinking and behaviour patterns. Witnessing
horrifying death of loved ones, friends or strangers, or killings, seeing many
mutilated or dismembered bodies, the decaying and bloated remains is bound to
saturate the consciousness with death and brutalize the personality. Similarly
watching with trepidation the destruction of a till then permanent structure, like his or
her home, or having to abandon it under forced circumstances can inevitably result in
the collapse of everything secure and strong, creating a vacuum that can never be
filled. With time people have become habituated to such scenes and experiences.
They have become immunized to the worst aspects of the war. At times, difficulties
have resulted in people fighting over limited resources or facilities, for example in
getting rations, or seats on the ship to Trincomalee.

One worrying development identified in many community focus group

discussions is the anti-social personality development in male adolescents and youth.
It was most noticeable after the Tsunami, where the adolescents and youth in
displaced camps seem to drift into anti-social groups and activities. Initially, during
the Tsunami they had behaved heroically saving many and actively helping in the
rescue efforts. In the camps too there were in the forefront in organizing activities,
programmes and services. However, many of them had lost a parent or sibling. Grief
seemed to soon overwhelm them. Further in some families the family dynamics soon
worked to blaming the youth for some of the deaths, not acting appropriately to save a
sibling for example. Thus guilt complicated the grief reactions. Further no ongoing,
constructive activities or programmes were designed and implemented for adolescents
and youth. They were left out of the school based programmes or those for children.
Unemployed, at a loose end they drifted into groups and antisocial activities. Some
left to join the militants. Others started using alcohol. Together with male widows,
alcohol became a major problem in the camps. Attempts to restrict the availability or
its use were not successful. Anti social activities also soon became a problem.

Similar antisocial personality development, particularly in male adolescents

and youths, was seen in the war settings. Their parents and elders in the community
who had traditionally been respected and followed no longer had control. Immersed in
an atmosphere of extreme violence, where many had witnessed horrifying death of
relations, the destruction of their homes and social institutions, displacement and
camp life, bombings, shelling and extrajudicial killings, war equipment and
paraphernalia, unemployment, poverty and no avenues for advancement or for the
future, adolescents and youth formed into groups and gangs. At workshops and
meetings with adolescents and youth, it was clear that there considerable pent up
anger and resentment against the military, which were seen as an occupying force,
responsible for atrocities and violence. The emotions and hostility were just beneath
the surface, when given an opportunity to express and ventilate their feelings within
the secure and enabling atmosphere of the workshops, the aggression came out
clearly. When asked to hit out (at objects like a pillow) if they felt like it, invariably
the pillow was imagined to be the military and considerable aggression was vented in
these group settings. Some discerning workers and INGO’s expressed concern at the
clever manipulation of this anger by pro militant organizations like drama groups for
recruitment and propaganda purposes. There was evidence for displacement of anger
in real life situations. There were inter gang conflict and violent fights, spilling over
into their communities. Thefts and other antisocial activities like abduction of
females, harassment and abuse became common. Parents, teachers and community

16
members expressed difficulties and fear in handling adolescents and youth. These
were the age group, who in normal times would have been involved in constructive
social activities, advancing and nurturing society with youthful exuberance and
altruism (Erikson, 1968).

Social deterioration
The signs of collective trauma can be seen in all social institutions, structures
and organizations in present day Jaffna. There is a general ennui. Most of have left
their houses and property in disrepair, not taking the effort to start repairs. In offices
and organization the work output had declined considerably. Once when the work
ethic had dominated this hard working society, most are now not inclined to work,
merely sign their names in the work register and take the day off at slightest excuse.
More effort and interest is spent on obtaining relief items, rations, incentive payments,
risk allowances and such like. There is a crisis of leadership. No one comes forward
to take leadership positions like chairmanship, presidency etc. Most positions go by
default. There is a complete lack of quality in all aspects of society, partly due to
crippling brain drain, but also the devastating effect of the war. As seen in the studies
of adolescents (Somasundaram, 1998), the marked impairment in cognitive
functioning can be discerned in adults also. Particularly there is a constriction,
narrowing of cognition, thinking in general has become very restrictive, petty,
mundane, fixed on survival and self-interest. A characteristic feature of
traumatization is loss of concern about the future, lack of planning. People learn to
survive from day to day.

There is a marked deterioration in social values as shown by sexual mores (for

example in the refugee camps in Vavuniya and in general society, medical personnel
report increased unwanted pregnancies, teenage abortions, child sexual abuse etc.),
social ethics (robberies of the houses and property of those displaced which is now
claimed as a right). The widespread looting by the public, indulged in even by socially
respectful teachers and others was seen in Thenmarachi around April, 1996 when the
army took over. There is currently a dramatic increase in the number of child abuse,
including sexual abuse, being reported in Jaffna to the District Child Protection
Committee (see Tables of DCPC statistics).

This could be due to increased awareness of the problem (child abuse always
being there in our society, but only now coming to light) but also due to the war
situation. Many families are displaced from their familiar surroundings and natural
habitat where there was the support and protection of others from the village, their
extended family and friends. They now have to live in crowded camps or
accommodation in strange and new places. Parents too have to go out to attend to
various urgent requirements like arranging for relief, meet authorities etc. Some
families are separated without their men. In some families, the mother has started
another relationship. Further there is a general deterioration in social values and
principles, a reduction in restraints and even

17
 CHILD ABUSE in Jaffna (2001-3)
40

35
No of cases

30

25

20

15

10

0
No De Fe Ma Ap Ma Jun Au Se No De Jan Fe Ma Ap Ma Jun Jul
Jan july Oct
v ce b rch r y e g p v c u b rch ril y e y

Number of Cases 3 11 15 12 13 11 8 11 11 19 21 19 24 19 32 20 29 12 24 28 34

Months

disinhibition due to the situation. There is also a noticeable increase in violence

against women (Fig. gives the number of cases seen through the Kavasam (Women
protection) programme at General Hospital Jaffna.

(V
18
 An example of deterioration in morale and loss of sensitiveness of being
human is from the health sector where, until recently, there was a spirit of service
(Somasundaram, 1997). Medical staff would stay with their patient, sometimes
sacrificing their own well-being for the interests of the patient. The collective
experience of what happened at General Hospital, Jaffna on Theepavali day in 1987
has made most staff loose their altruism. During that fateful period, staff decided to
stick to the hospital and patients despite considerable risk. When the Indian Army
entered and massacred both patients and staff, this last bit of service ideal died, too.
Staff now look after their self-interest first. At the slightest hint of trouble, they
abandon the hospital, their responsibilities, and patients, as happened during the
intensification of the conflict in May 2000.

Child Soldiers
It is in this context of psychological, social, economical and political
deprivation that recruitment of child soldiers becomes possible. A whole generation of
Tamil children are lost, who in the normal run of things, should become the energetic
developers of the Society. However, it may not be enough to just merely condemn the
recruitment of children, but to ask the deeper question, “why do children join the
militants”? It is as important to understand the context under which children become
soldiers and work to improve these conditions if this practice is to be effectively
prevented. They can be divided into push and pull factors (Somasundaram, 2001b).
Some of the push factors include, death of one or both parents or relations;
separations; destruction of home and belongings; displacement; lack of adequate or
nutritious food; ill health; economic difficulties; lack of access to education; not
seeing any avenues for future employment and advancement; social and political
oppression, and facing harassment, detention and death8. Opportunities for and access
to further education, sports, foreign scholarships or jobs in the state sector have been
progressively restricted by successive Sinhalese governments, despite the lip service
paid to maintaining ethnic ratios. Over time the discrimination and violence against
the minority Tamils have become institutionalized, entrenched within the system, so
much so that the state terror and oppression became more subtle and covert
(Somasundaram, 2004). The greatest impact of this kind of structural violence and
oppression is on the younger generation. It would be much more effective in the long-
term and a more permanent solution to bring pressure on the state to dismantle the
socioeconomic and political oppression the children face.
On the other hand, examining the pull factors, it becomes clear that the LTTE
turned to children and females to do their fighting as the older males are no longer
joining. The older youths have matured enough to see through the propaganda.
Children because of their age, immaturity, curiosity and love for adventure still
remain susceptible to 'Pied Piper" enticement through a variety of psychological
methods. From public displays of war paraphernalia, funerals and posters of fallen
heroes, speeches and videos, particularly in school; heroic songs and stories, cleverly
8
Tamil youth are the ones specifically targeted by the security forces in their checking, cordon & search
operations and generally detained for interrogation, detention, torture, execution or even rape. During the
so called “Operation Liberation” in 1987, youth were either summarily shot (Hoole et al. 1988) or shipped
off in chains to the Booza camp in the South by the army en mass. So when faced with the possible entry of
the army, many youth will rather join than face, in their eyes, certain detention and death. 15% of the 600
disappearances in 1996 within Jaffna were children. In the recent Druaiappa Stadium evacuation, and the
mass grave at Mirusuvil remains of children were found.

19
drawing out feelings of patriotism, restrictions on leaving for the target age group by
the LTTE and of course the actions of the Sri Lankan forces all have created a milieu
where they are psychologically compelled to join. More recently, the LTTE has
introduced compulsive military type training for all eligible ages in areas under their
control. Obviously this will instill a military thinking and lead to more joining. The
very strict restrictions on leaving LTTE controlled areas, particularly in the recruitable
age group, ensures that there is a continuing source of supply, as well as create a
feeling of being trapped. In this context, it is easy to understand why joining can
become an alluring alternative. Those responsible for the recruitment, training and
deployment of child soldiers should be charged as war criminals while the child
soldiers themselves should not be treated as criminals or juvenile delinquents as they
are now but be offered appropriate socio-economic and educational opportunities for
rehabilitation.
In these circumstances of recruitment of children, Tamil sociocultural and
religious institutions failed to protest. Apart from functioning as apologists, no Tamil
leader has dared to condemn. This paralysis maybe partly due to the action of the Sri
Lankan State in indiscriminate bombing, shelling, detention and torture, partly the
general social deterioration due to the war, but also the silence of the community
under totalitarian control by the Tamil militants. Only a few affected parents have
made muted protests. Thus the Tamil militants were allowed to function freely within
society to attract and pull children through their propaganda and psychological
pressure in the vacuum left by the abdication of social institutions.

Collective Strategies
It is not the intention of this particular study to cover the collective level interventions
which hopefully will be described in a subsequent paper or even a book!, but a brief
overview of models used and techniques will be attempted:

A practically useful holistic model was based on the WHO definition of health
shown in Table 1 which gives different interventions at the physical, psychological,
familial, social and spiritual dimensions. A second conceptual model again gives an
idea of the level and types of a variety of interventions (Fig. 1):

20
-Green, B. (eds.)(2003) Trauma,
Interventions in War and Peace: Prevention,
Practice, and Policy

21
A third model represents how services were deployed at the District level:

Management of Post Disaster

mental health problems
(at District Level)

Psychiatric care
at District Level

Psychiatrist, Psychiatric Nurses

& Multi Disciplinary Team for
Psychiatric Care of severe cases.

Primary Health Care

Primary Health Worker (eg. Doctors, RMP's, FHW's, Nurses, PHI)

To manage the effects of trauma (PTSD, anxiety, depression)

Community

Community level workers ( eg. Teachers, G.S, NGO, etc. ) and people
Manage Psychosocial Problems

• Multi disciplinary team - Psychiatric social worker, Clinical Psychologist,

Counsellor, Child therapist ( includes art, play, drama ), Relaxation
therapist and Occupational therapist.

Referral

22
The community level interventions (Somasundaram, 1997) that were found
to be useful are given below:

Community Approaches
Psychoeducation
Training of community workers
Public mental health promotive activities
Networking
Encourage indigenous coping strategies
Cultural rituals and ceremonies
Community interventions
Family
Groups
Expressive methods
Rehabilitation
Prevention

One of the important community strategies was to network with other

organizations to provide holistic, integrated support and help:

Networking
Governmental Non-Governmental
Organizations Organizations
(GO) Community Based
(NGO) Organization
(I)NGO (CBO)
Educational sector (L)NGO
School, Teacher,
Private institutions

Religious,
Spiritual
Organizations
Health Sector Disaster
Primary Health care
Survivors
Traditional
Healing

Judicial System
Human Rights
Extended
Family

Village
Family Non-State
Resources Father, Mother, Media
Village Leader, Information Actors
Sister, Brother
Elders, Midwife

23
 Conclusions

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